Title: An Open Label, Prospective, Single Center Study to Evaluate the Efficacy of Methyldopa & labetalol in Treatment of Patients with Pregnancy-induced hypertension
Author: Dr Deepanjali Lomte
DOI: http://dx.doi.org/10.18535/jmscr/v3i10.63
Background:Pregnancy-induced hypertension is associated with various adverse fetal and maternal outcomes. The use of anti-hypertensive drugs in pregnancy is controversial. We conducted a prospective study to evaluate the comparative effectiveness and safety of methyldopa and labetalol monotherapy in patients with pregnancy-induced hypertension. Objective: To compare the efficacy & safety of Methyldopa and Labetalol on Blood pressure in Pregnancy-induced hypertension (PIH) patients. Methods:Patients n= 60 pregnant women with blood pressure of 140/90 mm Hg or more with ≥1+ proteinuria and gestational age between 20-38 weeks were included in this prospective study. Cases were randomly divided into two groups of 30 each. Group –I received methyldopa (n=30) and Group II received labetalol (n=20). Blood pressure was measured at 0, 6, 24, 48 and 72 h of initiation of antihypertensive drugs. Patients were also followed up for development of adverse drug effects during this period. Results:Antihypertensive treatment with methyldopa was associated with reduction in systolic blood pressure (SBP) by 54 mmHg and diastolic blood pressure (DBP) by 30 mmHg at 72 h. For the same period treatment with labetalol was associated with reduction in SBP by 70 mmHg and DBP by 36 mmHg at 72 h. Conclusions: Labetalol was more effective than methyldopa in controlling blood pressure in patients with pregnancy-induced hypertension. Keywords: Antihypertensive, Pregnancy-induced hypertension(PIH), Pre- eclampsia, Methyldopa, Labetalol 1. Chesney LC. History. In Chesney LC (Ed): Hypertensive disorders in pregnancy. New York, Appleton, Century, Crofts, 1978: 17034.) 2. Roberts JM, Lain KY: Recent insights into the pathogenesis of pre- eclampsia. Placenta 2002, 23: 359–72. ) 3. Duley L: Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean. Br J Obstet Gynaecol 1992, 99:547-553. ) 4. Pregnancy. American Journal of Obstetrics and Gynecology 1990; 163: 1691 - 1712. 5. Ching-Ming Liu, Po- jen Cheng, Sheuenn-Dyh Chang. Maternal Complications and Perinatal Outcomes associated with Gestational Hypertension and Severe Preeclamsia in Taiwanese Women. Journal Formes Medical Association 2008; 107(2):129-138. 6. ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 2002; 77:67 -75 7. Giannubilo SR, Bezzeccheri V, Cecchi S, Landi B, Battistoni GI, Vitali P, Cecchi L, Tranquilli AL. Nifedipine versus labetalol in the treatment of hypertensive disorders of pregnancy. Arch Gynaecol Obstet 2012; 286:637-42. 8. El-Qarmalawi AM, Morsy AH, Al-Fadly A. Labetalol vs. methyldopa in the treatment of pregnancy-induced hyper-tension. Int J Gynaecol Obstet 1995;49: 125 -30. 9. Khedun SM, Moodley J, Naicker T. Drug management of hypertensive disorders of pregnancy. Pharmacol Ther 1997; 74:221-58.13.Mabie WC. Management of acute severe hypertension and encephalopathy. Clin Obstet Gynaecol 1999; 42:519-31. 10. Linton DM, Anthony J. Critical care management of severe pre-eclampsia. Intensive Care Med 1997; 23:248-55. 11. Lamming GD, Broughton Pipkin F, Symonds EM. Comparison of the alpha and beta blocking drug, labetalol, and methyl dopa in the treatment of moderate and severe pregnancy-induced hyper-tension. Clin Exp Hypertens 1980; 2:865-95. 12. Gallery ED, Saunders DM, Hunyor SN, Gyory AZ. Randomized comparison of methyldopa and Oxprenolol for treatment of hypertension in Pregnancy. Br Med J 1979; 1(6178):1591-4. 13. Welt SI, Dorminy JH 3rd, Jelovsek FR, Crenshaw MC, Gall SA. The effects of prophylactic Management and therapeutics on hypertensive Disease in pregnancy: preliminary studies. Obstet Gynaecol 1981; 57:557-65. 14. Ounsted MK, MoarVA, Good FJ, Redman CW. Hypertension during pregnancy with and without Specific treatment; the development of the children At the age of four years. Br J Obstet Gynaecol 1980; 87:19-24. 15. Michael CA. The evaluation of labetalol in the Treatment of hypertension complicating pregnancy. Br J Clin Pharmacol 1982; 13(1 Suppl):127S-131SAbstract
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